The greatest challenge for ProACT Adamawa has been the fragile health system, particularly in terms of human resources for health (HRH), one of the six building blocks of the health system. The inadequate health workforce in the laboratory affects other components of the health systems, such as: 1) medicines, vaccines and technology, 2) information, 3) governance and leadership, 4) health financing, and 5) service delivery.

The situation in Adamawa was such that one or two laboratory staff members did all the work in the laboratory, including phlebotomy, chemistry, hematology, immunology, malaria and tuberculosis (TB) microscopy. On average, there was a patient/staff ratio of 40:1 on clinic days. This situation applied to all the sites with regard to health workforce in the laboratories.

Earlier this year, two laboratory scientists at the Garkida General Hospital -- one of the five project sites -- were overburdened, attending to 30 to 40 HIV patients on clinic days -- while simultaneously serving non-HIV patients. Garkida General Hospital has enrolled nearly 1,200 HIV-infected patients into care since Management Sciences for Health (MSH[6]) began working at the site in 2008. But the shortage in laboratory staff made it difficult to efficiently deliver tests and results to patients. Some HIV-clinic patients were left unattended to and appointments were shifted, decreasing follow-up. Inadequate health workforce also meant that the few services rendered suffered in quality, and tests results were often late.

Tackling worker shortages

The ProACT state team opted for task shifting as a human resources response to the workforce shortage. The team identified a source for increasing the health workforce: students from the state college of health technology. The team collaborated with the State College of Health Technology Management to assign student medical laboratory technicians and assistants to ProACT-supported facilities for their pre-service training. These students had no knowledge in antiretroviral therapy (ART) laboratory services, mainly because their school curriculum had not made provision for such training.

The ProACT project team provided orientation and hands-on training at posting sites to equip them with basic knowledge of good laboratory practice, testing and counseling, laboratory system automation and quality management. This training was in addition to their routine laboratory practical training, and included different HIV program components, such as logistics management, record-keeping and tally card updates, HIV laboratory testing using standard operating procedures (SOPs), and job aids.

The initiative -- strengthened by the College management’s extension of students’ pre-service period from two to six months -- empowered the students to contribute to Adamawa State’s health system during training, while building skills for their professional service future.

“My capacity has been built to contribute to HIV & AIDS services,” shared student Yambayoh Magaji. “After my training I would like to work in a hospital that provides HIV & AIDS services.”

The ProACT team also re-routed sample-logging activities to nearby hospitals.

Three months into the program, there are measurable changes in laboratory services at Garkida General Hospital. Patients no longer have their appointments postponed due to staff shortages. Tally cards, temperature charts and records are updated daily. There have been remarkable improvements in turnaround time of test results from 72 hours to eight hours, which is also increasing enrollment and client retention.

Garkida Hospital’s HIV Laboratory Focal Person, Dahiru Sabo is excited. “Some clinic days I used to work alone in the laboratory -- often until 9 or 10 p.m. just to finish the work. But now I have some relief,” he said. “Our tally cards, temperature charts, and registers are up to date!”

This innovation is presently scaled up to four out of the five ProACT project sites in Adamawa State. The ProACT team is working with the State Agency for AIDS, Hospital Services Management Board and the School of Health Technology to institutionalize the pre-service program, to address the inadequate health workforce in the laboratories in the short term, and to develop a well-trained health workforce post-graduation in the long term.